Bulletin Today
APhA staff
Injection drug use shifts to psychostimulants
Researchers are finding that methamphetamine and other psychostimulants are increasingly implicated in the rising number of U.S. overdoses and HIV and hepatitis C outbreaks among individuals who inject drugs.
In a November 26, 2025, JAMA research letter, study authors found that the prevalence of injecting methamphetamine, but not opioids, surged more than 25 percentage points in the 18- to 24-year old age bracket and among individuals who inject drugs in the east north central and east south central regions of the United States.
Collectively, the analysis results “underscore the need for developing stimulant use disorder treatment strategies, improving the utilization of medications for opioid use disorder, and expanding harm reduction initiatives (e.g., syringe service programs) to mitigate the risk of injection-related harms,” the authors of the analysis conclude.
For the serial cross-sectional analysis, the research team leveraged the 2012 to 2023 Treatment Episode Data Set-Admissions, a body of information linked to 831,571 first-time adult admissions to treatment centers across 40 states. They documented a significant gain in the prevalence of methamphetamine injection—both with and without opioids—regardless of age, sex, race, ethnic background, or geographic area. ■
APhA voices concern over hepatitis B recommendation change
APhA expressed disappointment with CDC’s ACIP December 2025 decision to remove the universal recommendation for administering the hepatitis B vaccine dose at birth.
“This reversal rolls back a highly effective, evidence-based public health measure that has been in place since 1991,” the association noted.
APhA emphasized that the vaccine is safe, effective, and essential for preventing chronic hepatitis B virus infection and severe outcomes such as liver failure and cancer, particularly since infants born to mothers who are not hepatitis B virus carriers remain at risk from possible household and caregiver exposure.
“Pharmacists have a long history of helping to prevent disease transmission through vaccine recommendation and administration, including against hepatitis B,”
said Brigid Groves, PharmD, vice president of professional affairs at APhA. “We remain steadfast in our commitment to protecting patients across their lifespan. The science is clear: The hepatitis B birth dose saves lives, and there is no new evidence to justify delaying or removing this critical protection.” ■
Efforts continue to ease prior authorizations
OptumRx has announced that they will reduce reauthorizations for an additional 40 drugs starting January 1, 2026. The move is an effort to eliminate reauthorizations for chronic disease medications and adds two new drug classes: hormone therapy and knee osteoarthritis injectables.
The company said it was also expanding its automated solution—PreCheck Prior Authorization—that’s aimed at reducing approval times. They said that with the expansion, more patients will have their prior authorization approved before going to the pharmacy and, in some cases, before leaving their appointment.
Overall, efforts are underway to streamline prior authorizations. In June 2025, for instance, HHS announced a coordinated effort with multiple health insurers to streamline prior authorization processes for patients covered by Medicare Advantage, Medicaid managed care plans, Health Insurance Marketplace plans, and commercial plans.
Under the new HHS initiative, electronic prior authorization requests would become standardized by 2027. ■
Researchers scrutinize popular social media posts related to prescription drug promotion
In a November 13, 2025, JAMA research letter, authors noted that 511 of 740 social media posts hyped up efficacy claims, but only 247 of those same messages pointed out risks or adverse effects. The analysis looked at high-engagement online posts making promotional claims or discussing off-label use of three major drug classes: GLP-1 receptor agonists, ADHD stimulants, and autoimmune biologics.
Investigators considered 740 public posts on Facebook, Instagram, TikTok, and YouTube garnering more than 57.5 million views as of January 2025. Among them, 175 posts sensationalized drugs with descriptors such as “life-changing or revolutionary” or urged readers to take action by seeking more information from their physician or visiting a related website. Explicit disclosure of sponsorship was uncommon, evident in just 16 posts that had a marketing angle.
Importantly, the authors said, the bulk of posts originated with patients and lifestyle or celebrity influencers, while drugmaker messaging accounted for only 33 posts. The federal government has explored broadening direct-to-consumer advertising regulation to capture influencer partnerships and sponsored content, but the sheer number of individual content creators would make doing so challenging. ■
Is high-dose oral insulin effective for kids genetically at risk for T1D?
Findings from the POInT randomized trial, published November 29, 2025, in The Lancet, suggest that high-dose daily oral insulin does not prevent the development of islet autoimmunity but is associated with a significantly higher risk of adverse events than placebo.
Autoimmunity against pancreatic islet antigens, including insulin, is implicated in T1D; and researchers hypothesized that high-dose oral insulin, administered daily, might protect at-risk children.
The trial, conducted across five European countries, included 1,050 infants who were 4 to 7 months old and identified through genetic screening as having an elevated risk for developing islet autoantibodies.
The babies were divided into two treatment arms, with one-half receiving insulin made from human zinc-insulin crystals. Dosage was stepped up from 7.5 mg at age 2 months to 67.5 mg by age 3 years. The other children enrolled in the trial were assigned to placebo. Participants were followed up to age 6.5 years, by which time two or more islet autoantibodies had developed or T1D had been diagnosed in 10% of children in the intervention group and 9% of children in the control group.
Of 10,252 reported adverse events, 49.5% occurred in 96.0% of 528 participants in the oral insulin group, and 50.5% occurred in 95.8% of 522 participants in the placebo group.
Study authors noted that more research is needed to assess the benefit of primary oral insulin therapy for preventing diabetes in infants genetically at risk for T1D. ■
FDA updates labeling for fenofibrates
After a lengthy review, including considering findings from the PROMINENT clinical trial, FDA has updated the labeling requirements for fenofibrates. The updated labeling removes mention of any cardiovascular benefits associated with the drugs.
Results of the trial, which were published in NEJM in 2022, found that among patients with T2D, mild to moderate hypertriglyceridemia, and low HDL and LDL cholesterol levels, the incidence of cardiovascular events was not lower among those who received pemafibrate than among those who received placebo.
The labeling update also highlights the risks patients may face when prescribed these medications. For example, the PROMINENT data found that pemafibrate was linked to an increased risk of venous thromboembolism compared to a placebo. The new labeling specifically calls out that risk for health care providers and patients alike. ■